Provider Network Manager

Arizona, United States

Apply with AI Apply

Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must have 5+ years of experience in recruiting and managing provider networks, including negotiating, reviewing, and amending contracts with physicians, physician groups, integrated delivery systems, health systems, and ancillary providers. A strong understanding of various payment methodologies, including fee-for-service and value-based/risk, is required, along with a high level of business acumen, innovation, independence, and confidence. Experience with CMS STAR measures, local market relationships, and proficiency in Google or MS Suite are also necessary. A High School Diploma or equivalent and an unrestricted driver's license are the minimum educational and licensing requirements.

Responsibilities

The Provider Network Manager will be responsible for the development, maintenance, and management of an adequate provider network within an assigned geographic area, residing in Kentucky. This includes maintaining relationships and performing all provider relations activities, as well as negotiating and renegotiating contracts with providers. Key duties involve engaging internal experts and providers to identify cost and quality improvement opportunities, monitoring reports to ensure compliance, and regularly reporting on the status, risks, and opportunities within their area of responsibility. The role also supports the overall Network Team and assigned groups in improving performance in CMS STAR measures.

Skills

Provider network development

Provider network management

Contract negotiation

Contract review

Contract amendment

Physician contracting

Physician group contracting

Integrated delivery systems

Health systems contracting

Ancillary provider contracting

Fee-for-service

Value-based care

Risk-based contracting

Business acumen

Provider relations

Devoted Health

Medicare Advantage plans with personalized support

About Devoted Health

Devoted Health provides Medicare Advantage plans aimed at simplifying and making healthcare more affordable for seniors aged 65 and older. Their plans include services like provider and pharmacy searches, prescription drug coverage, and preventive care rewards. Members pay premiums for these plans, and the company may also receive government payments for managing Medicare benefits. What sets Devoted Health apart from competitors is their high level of customer service, featuring Devoted Health Guides who assist members in navigating their healthcare options and addressing common issues with traditional insurance. Additionally, they promote preventive care through the Devoted Dollars program, which rewards members for engaging in health activities. The goal of Devoted Health is to create a more compassionate and accessible healthcare experience for its members.

Waltham, MassachusettsHeadquarters

2017Year Founded

$2,194.5MTotal Funding

SERIES_ECompany Stage

HealthcareIndustries

1,001-5,000Employees

Benefits

Comprehensive health plan

401(k) retirement plan

Generous vacation and holiday time

Lyra mental health resources

Time off to vote

Risks

Increased competition from Medicare Advantage providers like Clover Health and Oscar Health.

Potential regulatory changes affecting Medicare Advantage plans by CMS.

Rising healthcare costs could impact the affordability of Devoted Health's plans.

Differentiation

Devoted Health offers personalized assistance through Devoted Health Guides for member support.

The company emphasizes preventive care with its Devoted Dollars rewards program.

Devoted Health integrates virtual and in-home care with top local providers.

Upsides

Devoted Health raised $287 million in Series E funding in 2024.

The company expanded Medicare Advantage plans to eight new states in 2023.

Devoted Health achieved a 5-star Medicare Advantage rating in Ohio in 2023.

Land your dream remote job 3x faster with AI

Try Jobo Free